Uncategorized

POLICY/FRIDAY FUNNY: Controlling Health Care Costs From the Bottom Up, By Michael L. Millenson

THCB regulars know that we love Michael Millenson, even if he is a swiftboater! Like some of these very vigorous THCB commenters, he’s been thinking a little about transparency!

News item: The Bush administration says it will publish the prices Medicare pays for common procedures in order to encourage comparison shopping. A private Web site immediately began posting some hospital prices. Mr. McClellan, is it? You’re here for the… ….colonoscopy. The Internet Special. I believe it’s $1,299.95 through the end of this week.

Quite right. As I’m sure you know, many people are still a bit squeamish about the idea of a tube being inserted up their…lower intestine, so we’re offering a real “bare bottom” price, if you get my drift. Before we begin, though, there are a few questions I need to ask. First of all, would you like anesthesia?

Don’t I need anesthesia? Mr. McClellan, we don’t believe it’s our role to dictate to consumers what they “need.” Should you wish to decline anesthesia, we will provide you with a set of headphones, loud music and a shiny new bullet to place between your teeth. However, in that case, we recommend strongly that you select the “extra-narrow gauge” endoscope equipment package. Endoscope? The tube that we put up your… Umm, I get the picture. But I’m still a little confused about the anesthesia not being included.

When you fly coach, Mr. McClellan, do you still expect the airline to provide you with a lavish meal? Our hospital will never compromise on your safety, but surely you cannot expect that in today’s competitive environment we will subsidize your comfort. I apologize for even mentioning it. How much does anesthesia cost? That depends on how long you would like to be sedated. We have very reasonable prices on “deep-sleep” packages that come in 15-minute units. You the empowered consumer decide how long you want to be sedated. We also offer the “all you can sleep” option, where we keep you sedated from just before the procedure starts until your doctor is totally finished. We think of this as being analogous to buying the full tank of gas at the car rental counter. Most of our customers believe the peace of mind this option provides is well worth the small extra expense, particularly if their colonoscopy takes longer than expected. I certainly agree with that. By the way, how long does a colonoscopy take? It varies, but with Dr. Hoover, about forty-five minutes. Dr. Hoover? Dr. Hoover comes standard with the colonoscopy package you selected. Quite frankly, since he retired from full-time practice a couple of years ago, the other physicians have found it close to impossible to match his fee. Naturally, at this price we can’t allow any substitutions. Now, if you don’t have any questions you’d like to ask me, I think we can begin. I do have just one question. If during my colonoscopy Dr. Hoover discovers a suspicious growth that might be cancerous, what happens next? Unfortunately, our hospital has found that it isn’t really profitable to get involved in the “post-surgical” part of the business. However, one of our customer service representatives will be delighted to provide you with some shopping tips on “pathology labs.”

 

Copyright 2006, Michael L. Millenson. Michael is an author, health-care consultant and visiting scholar at Northwestern University’s Kellogg School of Management. He can be reached at: m-millenson@northwestern.edu <b<

ADVERTS
Considering
plastic
surgery
? Research the

different types of plastic surgery
and find great

plastic surgeons
worldwide.

Livongo’s Post Ad Banner 728*90

Categories: Uncategorized

Tagged as: ,

15
Leave a Reply

15 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
14 Comment authors
Richard FerreiraScott HodsonKathy DuganRichard CuttsJim Recent comment authors
newest oldest most voted
Richard Ferreira
Guest
Richard Ferreira

Controlling costs from the bottom up as presented is humorous but unfortunately it also is very sobering. Almost everyone’s initial approach is to reduce the amount paid to the professional for the services rendered. Done in the vacuum, this may seem appropriate but in reality it has only a small impact on the total cost. The Medicare program began a process to try and define costs by implementing its DRG program as well as a Medicare reimbursement rate for professional services. Unfortunately they did not carry it out to its logical conclusion and even when it tried, their models were… Read more »

Scott Hodson
Guest

This clever piece of commentary highlights a growing trend in healthcare today: transparency. Information regarding hospital process quality and patient satisfaction is readily available on the internet. The more enlightened hospitals are providing procedure cost information. As consumers increasingly select their health care providers on the basis of cost and quality, providers will increasingly compete on these factors. Competitive success will require development of a solid quality management foundation encompasing: Strategy: including a clear linkage of quality and patient safety to the organizational strategy and a Board-driven imperative to achieve quality goals. Infrastructure: incorporating effective quality management technology, EMR and… Read more »

Kathy Dugan
Guest

I’m totally new to the “blog” area, but what has brought me here is twofold, first I am trying to understand, in depth, revenue cycle and secondly, I am looking for “stars” in this area. I have a company whose goal is to be number uno in healthcare consulting, they are already very well respected and getting close, who is looking to hire these people as partners to their venture. I need senior people 7+ years, with advance degrees and have been published for starters.
Can anyone HELP me?????

Richard Cutts
Guest

International nursing agency offering permanent and temporary jobs for nurses in various countries like USA, UK, Australia, etc.

Jim
Guest
Jim

What the @#$!? 1. Why is it that when you call your attorney, or any other professional for that matter, you get billed for the time spent during the phone conversation for every minute, but when a physician gets called they don’t get a dime? 2. Why is it that when you have a flat on your car at 3 AM with no spare, the guy that comes to fix your flat gets paid more than a pediatrician who goes for an emergency at the hospital at the same time? How much time and money was spent on the flat… Read more »

Michelle
Guest

I hate to say it, but it seems the only way for today’s physicians to get any respect and not deal with the hassle of paperwork is to demand cash upfront; deal with the patient and not the insurance company. Maybe offer to accept the Medicare rates from patients, since that is all that most physicians will get paid in the end in most cases. Too bad we can’t go back to when insurance companies did not exist and Medicare was just a thought. By the way, great post Mr. Milleson….it is now circulating around DC to all the GI… Read more »

Eye Doc
Guest

I think it’s great that Medicare patients will be able to see how paltry Medicare reimbursement to physicians is. In my experience, when this has occurred, patients are usually quite surprised that we get paid as little by Medicare as we do, and many of them have commented about how unfair it is. However, I’m not sure why Medicare patients would feel compelled to shop around for the lowest prices, or why they’d want to choose the lowest prices anyway.

jack daniels
Guest
jack daniels

Sonny,
how do you recommend we train new doctors? They HAVE to work on somebody, or else they will always be “new” doctors.
Remember, even moonlighting residents are SUPERVISED by attendings. As long as they are supervised, its not a problem.

Gregory D. Pawelski
Guest
Gregory D. Pawelski

Too funny!! For McFlappin’, nothing but the best; just call Roto-Rooter.

Sonny Saggar
Guest
Sonny Saggar

I have recently been made aware that unsupervised residents are moonlighting in emergency departments across the country, in breach of the work-week hours restriction. This is putting the public at risk in the hands of not just fatigued, but relatively inexperienced physicians, sometimes just 1 or 2 years out of medical school. The notorious American College of Emergency Physicians (ACEP) deliberately omitted to even mention this travesty (unsupervised residents masquerading as ED attending physicians) in their recent National Report Card. Instead, ACEP proceeded to condemn over 16,000 career emergency physicians for not having the ‘right’ feathers in their hats. Arbitrarily,… Read more »

Jared M. Rhoads
Guest

This is an expert demonstration of two logical fallacies: Appeal to Ridicule and Misleading Vividness.[1,2] Fortunately, as Google calculates it, the Northwestern University Philosophy Department is just a short walk from the Kellogg Business School.[3]
Jared M. Rhoads
The Lucidicus Project
[1] http://tinyurl.com/3hhfj
[2] http://tinyurl.com/n9r6j
[3] http://tinyurl.com/n266f

Trapier K. Michael
Guest

elliottg,
Has medicine stopped being serious? Has living and dying and saving people’s lives and having people
s lives be saved become trite?

Tom Leith
Guest
Tom Leith

> Should you wish to decline anesthesia,
> we will provide you with a set of headphones…
I should think it would be the medical staff in need of headphones and loud music.
This is hilarious!
t

elliottg
Guest
elliottg

The comment above reminded me of this,
“You have broken the Fifth Rule.
You have taken yourself too seriously.
What are the other rules? There are no other rules.”
– Pierre Dupont, Dupont Industries
It also reminded me of that old saying. “I want to die in my sleep like grandpa, not awake and screaming in terror like his passengers.” Consumerism is a great sop to those too oblivious to understand the real root causes of our impending healthcare crisis.

Trapier K. Michael
Guest

You missed your calling as a comedian, Professor Millenson. But while the awkward transition from a healthcare system in which care decisions are driven by physicians and bureaucrats to one in which the consumer is king will, at times, be as laughable as a fawn finding her legs, a world in which care can be driven by supply systems “without regard to…patients’ preferences” is downright scary. [1] Thanfully for you and me, most prefer humor to terror in their health policy commentary. Trapier K. Michael Harvard School of Public Health SM Candidate in Health Policy and Management [1] J.C. Robinson,… Read more »